Clin Infect Dis. 2019 Feb 1;68(4):586-596. doi: 10.1093/cid/ciy522.
We investigated whether adding community scheduled malaria screening and treatment (CSST) with artemether-lumefantrine by community health workers (CHWs) to standard intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) would improve maternal and infant health.
In this 2-arm cluster-randomized, controlled trial, villages in Burkina Faso, The Gambia, and Benin were randomized to receive CSST plus IPTp-SP or IPTp-SP alone. CHWs in the intervention arm performed monthly CSST during pregnancy. At each contact, filter paper and blood slides were collected, and at delivery, a placental biopsy was collected. Primary and secondary endpoints were the prevalence of placental malaria, maternal anemia, maternal peripheral infection, low birth weight, antenatal clinic (ANC) attendance, and IPTp-SP coverage.
Malaria infection was detected at least once for 3.8% women in The Gambia, 16.9% in Benin, and 31.6% in Burkina Faso. There was no difference between study arms in terms of placenta malaria after adjusting for birth season, parity, and IPTp-SP doses (adjusted odds ratio, 1.06 [95% confidence interval, .78-1.44]; P = .72). No difference between the study arms was found for peripheral maternal infection, anemia, and adverse pregnancy outcomes. ANC attendance was significantly higher in the intervention arm in Burkina Faso but not in The Gambia and Benin. Increasing number of IPTp-SP doses was associated with a significantly lower risk of placenta malaria, anemia at delivery, and low birth weight.
Adding CSST to existing IPTp-SP strategies did not reduce malaria in pregnancy. Increasing the number of IPTp-SP doses given during pregnancy is a priority.
NCT01941264; ISRCTN37259296.
我们研究了社区卫生工作者（CHWs）提供的社区疟疾筛查和治疗（CSST）联合磺胺多辛-乙胺嘧啶（IPTp-SP）标准间歇性预防治疗（IPT）是否会改善母婴健康。
在这项 2 臂、随机、对照试验中，布基纳法索、冈比亚和贝宁的村庄被随机分配接受 CSST 联合 IPTp-SP 或单独接受 IPTp-SP。干预组的 CHWs 在怀孕期间每月进行 CSST。每次接触时，都采集滤纸和血涂片，分娩时采集胎盘活检。主要和次要终点是胎盘疟疾、产妇贫血、产妇外周感染、低出生体重、产前检查（ANC）就诊率和 IPTp-SP 覆盖率。
在冈比亚，3.8%的妇女至少有一次感染疟疾，在贝宁为 16.9%，在布基纳法索为 31.6%。调整出生季节、产次和 IPTp-SP 剂量后，两组间胎盘疟疾无差异（调整比值比，1.06[95%置信区间，0.78-1.44]；P=0.72）。两组间产妇外周感染、贫血和不良妊娠结局无差异。在布基纳法索，干预组的 ANC 就诊率显著高于对照组，但在冈比亚和贝宁则不然。增加 IPTp-SP 剂量与胎盘疟疾、分娩时贫血和低出生体重的风险显著降低相关。
在现有的 IPTp-SP 策略中添加 CSST 并不能降低妊娠期间的疟疾发病率。增加怀孕期间 IPTp-SP 的剂量是当务之急。
NCT01941264；ISRCTN37259296。
